Background: Occlusion of the femoropopliteal artery can lead to claudication and can contribute to chronic critical ischemia. The Ankle brachial index (ABI) is established as a first-line screening tool for lower limb ischemia.
Objectives: Assessment of different techniques and outcomes of superficial femoral and popliteal artery Angioplasty in patients with lower limb chronic ischemia.
Patients and methods: This was a randomized controlled clinical trial. Our inclusion criteria included patients with chronic ischemia of lower limb and with femoropopliteal artery lesions. Exclusion criteria were patients with accompanying aorto-iliac occlusions or infra-popliteal occlusions. Medical history and complete examination were done. Laboratory and radiological investigations were obtained. We used combined endovascular and surgical treatment modalities, tailored to lesion complexity with follow up at 3,6 and 12 months.
Results: ABI postoperatively in the immediate period, the 3-month period, 6-month period, and the 12-month period was higher than preoperative ABI. (12%) of patients needed reintervention, and (19%) had an amputation during the 1 year postoperatively, 13 were minor amputations and only 6 had major amputations. (18%) of patients had flush occlusion of SFA, (33%) were with long segment stenosis or occlusion, (44%) had short segment stenosis or occlusion, and finally (5%) had subacute ischemia with sudden cut.
Conclusion:  Endovascular interventions combined with surgical modalities such as thrombectomy, thromboendarterectomy and open surgical vascular access as treatment   for femoropopliteal occlusive disease give better limb salvage rates in complex lesions.  Planning for treatment of femoropopliteal occlusive disease should be individualized according to type and lesion complexity to ensure best possible outcomes.